Systematic Review of Modern Case Series of Squamous Cell Cancer Arising in a Chronic Ulcer (Marjolin's Ulcer) of the Skin.

PURPOSE: Marjolin's ulcer is an aggressive cutaneous malignancy that arises in chronic nonhealing wounds. A review of modern series describing Marjolin's ulcer would be helpful in defining optimal management strategies and expected outcomes. METHODS: A systematic review was performed on October 18, 2018, by querying Medline and EMBASE. Key inclusion criteria were as follows: human studies, English language, published in 2000 or later, > 10 patients, and at least 80% of the patients having squamous cell carcinoma (SCC) histology. RESULTS: There were 599 patients in 14 case series from 10 countries; 82% of patients were from low-income and middle-income countries, and 48% were women. Overall, 65% of the ulcers were preceded by burns. Mean latency ranged from 11 years to 41 years (median, 28 years). Lower extremities were the most common site (62%). Differentiation was reported as well differentiated (64%), moderately differentiated (27%), or poorly differentiated (9%). Almost one third of cases were clinically node positive, though only 7% of all cases (24 of 334) were confirmed to be pathologically involved. Distant metastasis rates were reported in only 7 series, with median rate of 5% (range, 0%-27%). The main treatment modality was surgical excision (71%), followed by amputation (24%), primary radiotherapy (2%), and chemotherapy (< 1%). Outcomes data varied in content and quality. Mortality rates were 12%, 24%, and 37% in the three series reporting between 2 and 3 years of follow-up. CONCLUSION: Marjolin's ulcer with SCC histology is an aggressive cancer with a notable potential for lymph node metastasis and distant metastasis. Comprehensive staging is recommended, with management optimally having a multidisciplinary context. Low- and middle-income countries are overrepresented in reports of Marjolin's ulcer, and there may be opportunities for prevention and early detection.

Risk Factors for Sustained Cholera Transmission, Juba County, South Sudan, 2014.

We conducted a case-control study to identify risk factors for the 2014 cholera outbreak in Juba County, South Sudan. Illness was associated with traveling or eating away from home; treating drinking water and receiving oral cholera vaccination were protective. Oral cholera vaccination should be used to complement cholera prevention efforts.